Endoscopy is a minimally invasive surgical procedure which utilizes imaging apparatus for the purpose of providing a view of an interior portion of the body, without requiring that a large surgical opening be made in the patient to gain access to the surgical site. An endoscope is one type of such imaging apparatus which is placed in the body at the location at which it is necessary to perform a surgical procedure. Along with the endoscope, other types of surgical tools or instruments may be placed in the body at the surgical site so as to carry out a particular procedure. Examples of such instruments are cutting instruments, such as shaver-type devices which mechanically cut bone and soft tissue, or radio-frequency (RF) probes which are used to remove tissue via ablation or to coagulate tissue to minimize bleeding at the surgical site, to name only a few. In an endoscopic procedure, the surgeon views the surgical site through the endoscope in order to manipulate the other surgical instrument or instruments so as to perform the desired surgical procedure.
The development of endoscopes and their companion surgical instruments has made it possible to perform minimally invasive surgery that requires only small openings to be made in the patient, which openings are called portals. One advantage of performing endoscopic surgery is the reduction of the number of incisions made in the patient and/or the reduction of incision size, which reduces healing time after surgery. Still another advantage of endoscopic surgery is that it exposes less of the interior tissue of the patient's body to the open environment. This minimal opening of the patient's body lessens the extent to which the internal tissue and organs are open to infection.
In traditional endoscopic surgery, the endoscope and the surgical instrument are introduced to the surgical site through separate small portals, and once inside the patient, the instrument and endoscope must be correctly spatially oriented relative to one another through triangulation. Specifically, the surgeon must place the working end, typically the distal end, of the surgical instrument within the field of view of the endoscope so that the surgical instrument can be correctly manipulated, and must continually maintain this correct spatial relationship between the endoscope and the instrument throughout the surgical procedure. Since the surgical instrument and endoscope are inserted into the patient at varying angles and from separate locations, maintaining the correct spatial relationship between the two devices can be taxing on the surgeon. Further, during multiple-portal endoscopic surgery, surgical instruments, such as the blade of a surgical shaver or an RF probe, may collide with the endoscope optics, which can damage the endoscope and/or potentially cause a delay in surgery. Additionally, it can be difficult for surgeons to maintain the proper location of the endoscope within the surgical site during surgery.
While endoscopic surgery has been very successful in carrying out various surgical procedures, the medical field continually strives to lessen trauma caused to the patient during an endoscopic surgical procedure. For example, the number of portals created in the patient during knee arthroscopy has been reduced from three portals to two portals by expanding the functionality of the endoscope itself and of other surgical instruments to eliminate the need for a dedicated outflow portal. Further, the present trend in endoscopic procedures is to perform all necessary surgical functions through a single portal. One of the challenges presented by single-port surgical procedures is preventing stretching and/or tearing of the incision defining the single portal as the surgical instruments are manipulated and levered relative to the patient while the same extend into the patient through the portal.